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URINE 
TESTING 

UP TO DATE. 



y\ concise, and comprehensive JVlanuai of 
Urinary Analysis, including- maqy 
t0 tests not giveq in the stand- 

ard text books. 



DETROIT. 
NELSON, BAKER & CO . Publishers, 

i902. 



v \& 



THE LfSftAKY OF 

OOf*0«ES3, 
Two Copieb Receive© 

FEB. 17 1902 

0©pvqfQHT ENTRY 

CLASS a/XXa W*. 

copy a 



Copyright 1902 

BY 

Nelson, Baker & Co. 



INDEX. 

Albumin 5 

Bile Pigments 17 

Bile Salts 18 

Chlorides , 4 

Deposits 18 

Fleicht's Test 17 

Fouchlos' Test 9 

Horismascope. . .^ 6, 21 

I ndican 17 

J appe 's Test 17 

Johnson's Test 14 

Jolles' Test . 9 

Millard's Test 9 

Mulder's Test 11 

Oliver's Test 18 

Peptone 10 

Phosphates 3 

Physical Characters 1 

Reacti on f. 1 

Specific Gravity 1 

Spiegler's Reagent 9 

Sugar 11 

Sulphates 3 

Urea 2 

Uric Acid 4 



ROUTINE FOR EXAMINATION 
OF A 
SPECIMEN OF URINE* 



1. Observe the physical characters of the speci- 
men, noting particularly its color and odor, and the 
presence or absence of any visible deposit. 

2. Test the specimen for acidity with a slip of 
blue litmus paper, for alkalinity with red litmus 
paper. If the latter be turned blue, dry it. The 
blue color is retained if a fixed alkali is present: if 
the red color returns, the alkalinity is due to am- 
monia. Urine normally is acid. 

3. Determine the specific gravity of the urine. 
This is most conveniently done by aid of a urino- 
meter. Remember that temperature affects the 
specific gravity. If the temperature of the speci- 
men be above 60 : F.. add to the reading of the 
urinometer 0.001 for each eight degrees in excess 
of 60. Thus if the rrading be 1.017 on a warm 
day in summer, the temperature being near 84% 
add 0.003. making the corrected specific gravity 
1.020. 

An abbreviated urinometer. much less fragile 
than the ordinary instrument, and having only a 



ROUTINE FOR EXAMINATION 



single mark corresponding with a specific gravity 
of 1 .005 may be employed when great exactness is 
not required. In most cases the urine will be of a 
higher specific gravity than this, the instrument 
floating so that the mark is .quite above the level of 
the liquid. Add to half a fluidounce of the urine, 
carefully measured, an equal volume of water and 
test once more. If the mark is still above the 
surface, add to the mixture half an ounce more of 
water, and continue to test thus until water enough 
%^fias been added to bring the mixture to such a 
density that the mark will coincide with the sur- 
face of the liquid. Reckon for each half-ounce 
of the final volume of the fluid .005 to be added to 
unity for the specific gravity of the original urine. 
Thus if 2 1-4 fluidounces of water have been added, 
making the volume 2 3-4 fluidounces, the .005 must 
oe multiplied by 5 1-2, giving as the required 
specific gravity 1.027. The usual correction for 
temperature must be made as already explained. 

The last two figures in the specific gravity 
may be taken as approximately the number of 
grains of total solids to the fluidounce. More 
exactly, these figures multiplied by the coefficient 
of Haeser, 2.33, will give parts per thousand ( grams 
per liter) of soHds. In normal urine one half of 
the total solids, thus estimated, may be assumed 
to be urea. 

4. Test to determine whether urea is present in 
normal amount. Place on a glass Slide a drop of 



OF A SPECIMEN OF URINE. 



the urine and add a drop of strong nitric acid. 
Crystals of urea nitrate form rapidly in dense urine, 
only after some time in urine of low specific gravity. 
Judge by the amount of crystallization the quantity 
of urea present. 

5. Test for Sulphates. Add to 60 minims of the 
urine in a test tube first a few drops of hydrochloric 
acid, then a few drops of a solution of barium 
chloride (1:20). A finely divided white precipitate 
of barium sulphate is thrown down. If the test is 
made in the tube of a centrifuge, the quantity of 
barium sulphate may be quite accurately read off 
after whirling, and it can be seen thus whether the 
sulphates are present in normal proportion. 

6. Test for Phosphates, (a) Total phosphates. 
Put into a test tube four fluidrachms of the urine, 
add 30 minims of magnesia mixture (magnesium 
sulphate, 1 pavt; ammonium chloride, 1 part; wa- 
ter of ammonia, 1 part; water, 8 parts); the pre- 
cipitate of magnesium phosphate should render the 
mixture milky white throughout in a normal urine. 
The quantity may be estimated by aid of a centri- 
fuge. Instead of magnesia mixture, we may use 
uranium acetate for the precipitation. 

(b) Earthy phosphates. Put into a test tube 
four fluidrachms of the urine, add 10 minims of 
water of ammonia, warm and set aside a few min-" 
utes. The precipitate of calcium and magnesium 
phosphates should occupy one-sixth to one-eighth 
of the volume of the fluid. The precipitate may be 



ROUTINE FOR EXAMINATION 



collected on a filter, washed with water containing 
ammonia, dissolved in acetic acid and precipitat- 
ed with uranium acetate, and the amount of pre- 
cipitate then observed by aid of the centrifuge, for 
more exact quantitative results. 

7. Test for Chlorides. Place in a test tube 60 
minims of the urine and add a few drops of pure 
nitric acid, then a few drops of a solution of silver 
nitrate 1:25. A heavy curdy precipitate should 
be produced. If the chlorides are diminished the 
fluid is simply rendered milky, the silver chloride 
collecting in flakes only after some time or not at 
all. The quantity of chlorides may be quite ac- 
curately determined by measuring the volume of 
the precipitate after whirling in the centrifuge. 

If albumin is present, it must be removed by 
boiling with a little acetic acid and filtering before 
testing for chlorides. 

8. Test for uric acid. To two fluidounces of the 
urine add half an ounce of ammonium chloride, 
dissolve and set by in a cold place two hours. The 
uric acid will be thrown out of solution in combina- 
tion with ammonia, and the amount may be judged 
by the volume of the precipitate, especially if a por- 
tion is whirled a few minutes in a centrifuge. 
Exact determination of the uric acid may be made 
by collecting the precipitate (from 100 c. c. of 
urine) on a filter, washing three times with a satu- 
rated solution of ammonium chloride, washing from 
the filter with a jet of hot water, heating to boiling; 



OP A SPECIMEN OF URINE. 



with hydrochloric acid: after two hours standing in 
the cold collecting the uric acid, dissolving in warm 
sodium carbonate solution adding 20 c. c. of strong 
sulphuric acid and titrating the warm solution with 
potassium permanganate, one twentieth normal. 
For each c. c. of the volumetric solution con- 
sumed, reckon 3.75 mg, uric acid. 

9. Test the specimen for albumin, (a) Apply- 
first Tanret's test, the double iodide of mercury and 
potassium. If this gives a negative result, albumin 
is certainly absent and the other tests for albumin 
may be omitted. A precipitate or cloudiness may, 
however, be produced in absence of albumin, caused 
by other proteids. by alkaloids or possibly by urates 
or mucin. Heat the mixture containing the pre- 
cipitate; if it remain undissolved, it consists prob- 
ably of albumin. Confirm by other reagents, par- 
ticularly potassium ferrocyanide. 

MODE OF MAKING THE TEST. 

Tanret's reagent is made by dissolving in 12 
fluidounces of water 289 grains of potassium iodide 
and 118 grains of mercuric chloride (corrosive sub- 
limate) and adding 4 1-2 fluidounces of acetic acid. 
If tablets are used, dissolve one potassio-mercuric 
and one citric acid tablet in 30 minims of water. 
Put into a test tube a fluidrachm of the urine, which, 
if not perfectly clear should be made so by filtra- 
tion and add a little of the reagent, allowing it to 
flow down the side of the tube. If a precipitate 
forms, heat to boiling, when the precipitate, if not 



ROUTINE FOR EXAMINATION 



due to albumin, will generally clear up, to return 
on cooling. 

Use of Horismascope. The test may be advan- 
tageously made in the horismascope. In this case 
dissolve in the reagent prepared as above one of the 
large tablets of sodium' sulphate to increase its 
density. Put into the horismascope two fluid- 
rachms of the clear urine Incline the instrument 
so that the fluid will rise to the very top of the nar- 
row tube, without overflowing into the funnel. 
Then pour into the funnel about 30 minims of the 
reagent which will flow down the small tube and 
form a layer underlying the urine. At the plane of 
contact between the strata of fluid there will form 
at once a milky ring very distinctly seen against 
the dark background of the instrument. A minute 
trace of albumin will in this way be easily detected. 
Remember, however, that the cloud may be due to 
something besides albumin, and proceed to apply 
confirmatory tests for albumin. Remember also 
that the solution containing a large amount of 
sodium sulphate may not clear up on heating even 
if the precipitate is not one of albumin. 

(b) As a confirmatory test, use potassium fer- 
focyanide since this reagent produces no precipitate 
unless albumin is present. It will detect one part 
of albumin in 12,000 of fluid, being therefore a 
much less sensitive reagent than the last mentioned. 
Dissolve a ferrocyanide and a citric acid tablet in 
30 minims of water and add 15 minims of the clear 



OF A SPECIMEN OF URINE. 



urine. Do not boil, as this reagent is decomposed 
by heat. The test may be made in the albumo- 
scope, one of the tablets of sodium sulphate having 
been dissolved in the reagent to give it the requisite 
density. 

(c) Many physicians will prefer to use nitric 
acid as a confirmatory test. Heller's modification 
of the test is the best for ordinary use, and may be 
made conveniently in the horismascope. Put into 
the instrument two fluidrachms of the urine render- 
ed clear if necessary by filtration. Tilt the instru- 
ment so that the fluid will completely fill the small 
tube, otherwise the air in the tube may prevent the 
acid from flowing into it. Pour into the funnel 20 
or 30 minims of strong nitric acid which will flow 
down and form a layer underlying the urine. If 
albumin is present a white ring will form at the 
plane of contact of the fluids, very distinctly seen 
against the black background. The characteristic 
color produced by the action of the acid on the 
coloring matter of the urine will also be well seen 
against the background of white. 

A hazy ring forming slowly a little distance 
above the plane of contact is likely to consist of acid 
urates. In such case if the turbid fluid is transfer- 
red by a pipette to a test tube and warmed, it clears 
up. A cloud may be produced by oleo-resins, 
which differs from that due to albumin in that it is 
cleared up on addition of alcohol. 

The quantity of albumin present may be judg- 



ROUTINE FOR EXAMINATION 



ed by the appearance of the white ring or zone. If 
this is only faintly white without granular appear- 
ance, having a depth of less than 4 mm. (1-6 inch*) 
the quantity does not exceed one fourth of one per 
cent. If the zone is opaque white slightly granular 
and 4 to 6 mm. (1-6 to 1-4 in.) in depth, the quantity 
is as much as 1-4 to 1-2 per cent. When the 
quantity is greater than this the zone is distinctly 
flocculent and even curdy in appearance. 

Further details regarding the nitric acid test 
will be found in any treatise on urinalysis. The 
test by boiling is also too well known to require 
repetition here. 

(d) Acidulated brine constitutes a useful test 
readily made by aid of the horismascope. The 
reagent consists of a saturated solution of sodium 
chloride [common salt answers every purpose] to 
which has been added five per cent of diluted 
hydrochloric acid U. S. P. Very similar to this is 
the nitric-magnesian fluid of Dr. Roberts which is 
prepared by adding to a cold saturated solution of 
magnesium sulphate one fifth of its volume of 
strong nitric acid. This is used precisely in the 
same manner as nitric acid, and is particularly well 
adapted for use in the albumoscope. Peptones, 
however, as well as albumin may be precipitated 
by this reagent. 

(e) Picric acid forms a very delicate test for 
albumin, although, like Tanret's reagent it precipi- 
tates some vegetable alkaloids, oleo-resins, etc # 



OF A SPECIMEN OF URINE. 



Heat redissolves all but the albumin precipitate. 
* (f ) Sodium Tungstate as a reagent for albumin 
is nearly as sensitive as the potassio-mercuric iodide. 
It precipitates peptones, but heat redissolves the 
precipitate. In using the tablets of picric acid or 
sodium tungstate follow the directions given un- 
der (a). Another method of procedure, applicable 
with any of these tablets is the following: Add to 
30 minims of the urine a citric acid tablet and shake 
until dissolved. A cloudiness may be produced by 
mucin, by uric acid, or sometimes by oleo-resins, 
as where balsam copaiba has been taken medici- 
nally. On heating the urine clears again except 
where mucin is present. To the urine, cleared if 
necessary by filtration, the albumin precipitant is 
then added, the tablet having been first dissolved in 
a little water. 

(g) Spieglers' Albumin Reagent consists of cor- 
rosive sublimate, 20 grs.; tartaric acid, 10 grs.; dis- 
tilled water, 1 fluidounce; pure glycerin, 40 minims. 

(h) Millard s Albumin Reagent consists of car- 
bolic acid, 2 fluidrachms; glacial acetic acid, 7 
fluidrachms; liquor potassae, 3 fluidounces. 

(i) Fouchlos uses the following reagent: potas- 
sium sulphate, 40 grs.; watei, 6 fluidrachms; acetic 
acid, 80 minims 

(j) Jolles' Reagent consists of corrosive sub- 
limate, 10 grs.; sodium chloride, 10 grs.; succinic 
acid, 20 grs.; distilled water, 1 fluidounce. Mix 
30 minims of the urine with 15 minims of acetic 



10 ROUTINE FOR EXAMINATION 



acid, add 60 minims of the reagent and shake. In 
another tube mix 60 minims of the urine with 
15 minims of acetic acid. The most minute traces 
of albumin are detected with certainty by this re- 
agent. Of course the contents of the second tube 
should remain clear. Otherwise the result of the 
test remains in doubt. 

The quantity of albumin present may be quite 
accurately determined by adding to 6 c. c. of the 
urine a solution made by dissolving in 4 c. c. of wa- 
ter one picric acid tablet and one citric acid tablet. 
The mixture is whirled in a centrifuge at low speed 
three minutes, when the quantity of precipitate may 
be read off. Reckon for each c. c. of precipitate 
0.2 per cent, by weight of albumin. 

10. If in applying tests for albumin there have 
appeared indications of the presence of peptones, a 
special test should be made for these as follows: 
Place in the horismascope two fluidrachms of the 
urine, pour into the funnel tube 30 minims of 
Fehling's solution and set the instrument by for a 
few hours. If peptones are present, a violet color 
develops at the plane of contact of the fluids ex- 
tending upwards into the urine which ultimately 
(perhaps after two days) becomes tinged through- 
out. This is known as the biuret test and the re- 
action is very characteristic. If albumin is present, 
it must be removed by boiling (after addition of a 
little acetic acid) and filtering before testing for 
peptones. 



. OF A SPECIMEN OF URINE. 1 1 

11. Test the urine for Sugar. 

(a) Apply Mulder's test which consists of 
indigo carmine associated with sodium carbonate. 
The reagent is prepared by simply dissolving one 
of the indigo carmine tablets in 60 minims of -wa- 
ter. The solution is heated to the boiling point, 
one drop of the urine is added from a pipette ar.d 
the solution kept just at the point of ebullition, but 
not permitted to boil for 60 seconds. If no change 
is produced add another drop of urine and heat again 
60 seconds. If sugar is present in abnormal quantity 
the color of the solution changes from pure blue to 
violet then successively to red. orar.ge and finally 
a pale straw color. If the quantity of sugar be 
small, the final pale color may not be reached. If 
the tube be shaken so that the fluid comes in con- 
tact with oxygen from the air. the original blue 
color is rapidly restored. 

Remember that normal urine contains a reduc- 
ing agent which will produce the changes of color 
described if a larger quantity of urine ( from five to 
ten drops') be used. If sugar is present in quantity 
to indicate a pathological condition, two drops will 
produce the change at least to red, 

If one drop of urine is used, the series of color 
changes will be complete in 30 seconds when the 
urine contains 35 grains or more of sugar to the 
fluidounce. in 60 seconds when the quantity present 
is 10 grains, in two minutes when it amounts to 5 
grains. If at the end of two minutes the color is 



12 ROUTINE FOR EXAMINATION 

reddish yellow the quantity is 4 grains, if red, three, 
if purple, two, if violet one grain to the fluidounce. 
In urine containing more than 10 grains of sugar 
to the ounce, the quantity can be best determined 
by diluting until a single drop reduces the indigo 
completely in 60 seconds. The diluted soecimen 
may be assumed then to contain 10 grains of sugar 
to the fluidounce. 

b. If Methylene blue is substituted for indigo car- 
mine, the presence of glucose will be indicated by 
simple decoloration of the solution, the color being 
restored as in the case of indigo by shaking the 
fluid so that it will come in contact with the oxygen 
of the aii. Litmus blue is also decolorized in alka- 
line solutions by boiling as is safranin, a red color- 
ing matter. In each case the loss of color is due 
to deoxidation. The same is true again of the loss 
of color of a freshly prepared solution of potassium 
ferricyanide (red prussiate). This test may be 
made a very delicate one in the following manner. 
Dissolve a grain of the red ferricyanide in 30 minims 
of water, add ten minims of liquor potassas and a 
single drop of the urine. Heat the mixture to boil- 
ing, add hydrochloric acid in slight excess and then 
a drop of a solution (1:50) of ferric chloride, free 
from ferrous salt. If sugar is present, a blue pre- 
cipitate will be thrown down. 

c. Apply the Copper test for glucose, in the fol- 
lowing manner (method recently published by Dr. 
A. B. Lyons). Put into a test tube 30 minims 



OF A SPECIMEN OF URINE. 13 

( measured) of the urine with one copper test tablet, 
one fourth of a citric acid tablet and two sodium 
carbonate tablets. Heat to boiling and boil one 
minute. If much sugar is present there will prob- 
ably be thrown down a deposit of red cuprous oxide, 
hut whether this appear or not, add to the solution 
a few drops of dilute hydrochloric acid, just suffi- 
cient to render it acid, making it also transparent. 
Add four fluidrachms of water, then a few drops of 
a solution ( 1:20) of potassium iodide. If sugar is 
present a white precipitate is thrown down. Nor- 
mal urine will always reduce a certain amount of 
copper, so that if the water is not added a distinct 
precipitate will be thrown down, but this will be 
sufficient only to produce a slight turbidity in the 
dilute solution. If the urine contains as much as 
0.25 per cent, of sugar (about 1 grain to the fluid- 
ounce), the dilute fluid will be strongly clouded. 

The test may be modified by substituting for 
the citric acid about 1-8 grain sodium salicylate. 
If the urine is strongly acid it may be necessary to 
use mere than one tablet of sodium carbonate: one 
Will generally suffice when sodium salicylate is 
used in place of the citric acid. 

Another method of making the test is to put in 
a test tube 30 minims of a dilute Fehling's solution 
— the ordinary Fehling's solution diluted with 5 
to 8 times its volume of water, so that it is of 
a pale blue color — add 5 drops of the urine, boil 
one minute, render acid with hydrochloric acid and 



14 ROUTINE FOR EXAMINATION 

without diluting add two drops of a clear solution of 
potassium iodide. If sugar is present in the pro- 
portion of 2 grains to the fluidounce, a distinct 
precipitate will be thrown down. If a heavy pre- 
cipitate is produced, repeat the experiment using 
only one drop of the urine. If turbidity is produced 
in this case by adding the potassium iodide, the 
quantity of sugar exceeds 5 grains to the fluid- 
ounce. When there is as much sugar as this pre- 
sent, it will be generally detected by precipitation 
of cuprous oxide if the dilute Fehling's solution is 
employed with not more than four or five drops of 
the urine. 

d. Apply Dr. Johnson's picric acid test. Put in- 
to a test tube 30 minims of the urine, add one tab- 
let of picric acid and 15 minims of liquor potassas, 
U. S. P. and boil one minute. The color is always 
darkened, but if sugar is present is changed to a 
deep red brown. Prepare a color standard by dis- 
solving in a mixture of 5 fluidrachms of water and 
two fluidrachms of diluted sulphuric acid, U. S. P., 
22 3-4 grains of potassium bichromate. Dilute the 
brown fluid obtained in the test with water until it 
is as nearly as possible of the same' tint as the 
standard. Measure the solution, deduct five fluid- 
rachms for "normal sugar", and reckon for each 
fluidrachm of the remainder 06 grain of sugar to 
the fluidounce. For this simple and practically 
exact method of determining sugar quantitatively in 
urine we are indebted again to Dr. A. B. Lyons. 



OF A SPECIMEN OF URINE. 15 



If the results obtained coincide with those of the 
copper test described above, there can be no ques- 
tion of their substantial truth. 

e. Some physicians prefer to rely upon the 
Bismuth test, which, in any case, may be made in 
confirmation of the preceding. Put into a test tube 
a fluidrachm of the urine, add 15 minims of liquor 
potassas, U. S. P. and a tablet of bismuth subni- 
trate and boil at least one minute. If sugar is pre- 
sent, the bismuth assumes a dark color, becoming 
quite black when the quantity is large. Sulphur 
will also blacken the bismuth, and this element is 
present In albuminous urine. In case there is a 
darkening of the bismuth, therefore, boil another 
sample of the urine with a tablet of lead carbonate 
and some liquor potassas. If the lead is darkened, 
sulphur is present, and the result of the bismuth test 
must be regarded as valueless. 

In all tests for sugar, make sure that albumin 
is absent. Should there be albumin in the urine, 
coagulate it by boiling with a few drops of acetic 
acid and remove by filtration before testing for 
sugar. 

f. The tests hitherto described are all faulty in 
that other substances besides sugar may produce 
the same reactions and such substances (as e. g. 
uric acid ) are known to be present even In normal 
urine. There is one test practically free from this 
objection. Phenyhhydrazin reacts with sugar to 
produce a nearly insoluble compound, and so serves 



16 ROUTINE FOR EXAMINATION 

as a specific test for sugar. 

The test may be made thus (Allen): Heat to 
boiling four fluidrachms of the urine, add 2 fluid- 
rachms of a solution of lead acetate (1:10); boil and 
filter hot. Add sufficient solution of caustic soda 
to redissolve the precipitate which forms at first, 
then as much phenyl-hydrazin as will lie on the point 
of a pen knife and boil the mixture for some 
minutes and then make acid with acetic acid. 
If much sugar is present an immediate yellow 
turbidity is produced. Traces of sugar are shown 
by a yellow coloration, the solution generally be- 
coming turbid on standing. 

The use of Pavy's, Fehling'sand Knapp's solu- 
tions for quantitative determination of sugar in the 
urine will be found in the larger text books on urine 
analysis, as will be also details of the fermentation 
test. 

g. The horismascope may be used in testing for 
sugar in the following manner Place in the in- 
strument a mixture of 20 minims of Fehling's solu- 
tion with two fluidrachms of water. Pour into the 
funnel tube a mixture of 15 minims of the urine with 
15 minims of clear saturated solution of common 
salt, and let the instrument stand over night. 

If much sugar is present, red cuprous oxide 
will deposit at the plane of junction of ;he fluids, a 
portion of it settling at last to the bottom of the tube. 
This is a good confirmatory test of the presence of 
sugar, but does not detect with certainty mere 



OF A SPECIMEN OF URINE. 17 

traces of that substance. 

12. Test the urine for Indican by mixing 20 
minims of it with a fluidrachm of strong hydro- 
chloric acid. In normal urine only a reddish color 
is developed. If indican is present in excess, the 
color is violet or distinctly blue. The test may be 
made in the horismascope in the following manner. 
Place in the instrument two fluidrachms of the 
urine. Pour into the funnel tube a mixture of 30 
minims of strong hydrochloric acid with one minim 
of a ten per cent, solution of potassium nitrate. 
The colors produced are the same as above. Jappe s 
test is made by adding to two fluidrachms of the 
urine an equal volume of hydrochloric acid and 30 
minims of pure chloroform, then adding drop by 
drop a freshly prepared solution of chlorinated lime, 
shaking after each addition. If indican is present 
in excess, the chloroform assumes a violet or blue 
color, which fades when an excess of chlorinated- 
lime is added. 

13. Test for Bile Pigments. Put into an horis- 
mascope a mixture of 30 minims of nitric acid with 
30 minims of the urine. Pour into the funnel tube 
30 minims of strong sulphuric acid. The presence 
of bile pigments is shown by the appearance of a 
grass green ring at the plane of contact of the fluids. 
This is known as Fleicht's test and is altogether the 
most delicate test we have for bile pigments, pro- 
vided these are not already oxidized. 

Another method of making the test is to place 



18 ROUTINE FOR EXAMINATION 

in the horismascope two fluidrachms of hydrochloric 
acid to which has been added just enough of the 
urine to color it distinctly, then to pour into the 
funnel tube 30 minims of strong nitric acid. The 
characteristic colors, produced just above the plane 
of contact, are vividly developed. 

14. Test for Bile Salts, Evaporate two fluid- 
ounces of the urine on the water bath to dryness. 
Extract the residue with about 90 minims of alco- 
hol, filter and add 2 fluidounces of ether. Collect 
the scanty precipitate which forms after a time on 
a filter, wash it with ether, dissolve it in 20 minims 
of pure water. Add to this solution one drop of a 
mixture of simple syrup with four times its volume 
of water, transfer to the horismascope and underlay 
it with strong sulphuric acid. The presence of bile 
acids is shown by a purple-red color, but the test 
often fails even in experienced hands. 

Dr. Oliver's test consists of a solution of pep- 
tone, 4 grains and acetic acid 4 minims in a fluid- 
ounce of water. The reagent is placed in an horis- 
mascope and 30 minims of the urine is poured into 
^he funnel tube. If bile salts are present, a milky 
zone develops. Normal urine may show the re- 
action very faintly. 

15. Examine the Deposit if any, in the urine. 
If little or no deposit is noticeable in the specimen, 
put a portion of it into the tube of a centrifuge and 
whirl a few minutes, when the deposit will be found 
concentrated at the bottom of the tube. 



OF A SPECIMEN OF URINE. 19 

DIAGNOSIS OF THE DEPOSIT. 

a. It is amorphous, i. e. the particles show no 
definite shape under the microscope. 1. If the de- 
posit is bulky and of a tawny color it probably con- 
sists of urates. In this case it will redissolve if the 
urine containing it is heated moderately. If a por- 
tion of the deposit is dissolved in a few drops of hot 
water, a drop or two of acetic acid added and a drop 
of the mixture is placed on a slide under the micro- 
scope, crystals of uric acid will presently separate, 
recognized by their shape and by chemical tests. 
2. If the deposit is bulky and nearly white, it prob- 
ably consists of earthy phosphates. The urine 
will be found to be alkaline or neutral, and on ad- 
ding a few drops of acetic acid, the deposit will 
dissolve. Generally there will be crystals also pre- 
sent of the so called triple phosphate. To prove that 
the deposit consists of phosphate, collect on a filter, 
wash once with water, dissolve by aid of a little 
acetic acid and add solution of uranium acetate, 
which will throw down a yellowish precipitate. 

b. The deposit is crystalline. In most cases 
the crystals will be recognized at once under the 
microscope. The most common forms are 1 . The 
large prisms or snowf lake-like stars of triple phos- 
phate; 2. The minute octahedra or, less com- 
monly, the dumbell forms characteristic of calcium 
oxalate. The deposit may be granular rather than 
distinctly crystalline, and is then distinguished from 
earthy phosphates by the fact that it is insoluble in 



20 ROUTINE FOR EXAMINATION OF URINE. 

acetic acid, but dissolves in hydrochloric acid: 3. 
Uric acid, consisting generally of reddish grains 
(brick dust), occasionally nearly colorless, exhibit- 
ing a great variety of shapes, yet generally recog- 
nized without difficulty. They do not dissolve in 
acids of moderate strength, but are quickly dissolv- 
ed by liquor potassae, being reprecipitated in charac- 
teristic shapes by adding acetic acid in excess 4. 
Urates, which are also soluble in potassa, and re- 
precipitated as uric acid by acetic acid. Besides 
these, crystals of Cystin, Leucin and Tyrosin are 
occasionally met with and readily recognized by the 
microscope and by characteristic chemical reac- 
tions. 

c. Organized Deposits. These include 1. Epi- 
thelial cells; 2. Blood corpuscles; 3. Mucus and 
pus cells: 4. Tube casts from the kidneys: 5. Sper- 
matozoa, the recognition of which is a simple matter 
to the experienced microscopist. 



THE HORISMASCOPE 

Was devised originally to render more easy and 
certain the detection of albumin in urine. The 
name Albumoscope was therefore given to it, and 
under this name it has become widely known to 
physicians. The instrument enables the operator 
to apply a reagent of high specific gravity, like 
nitric acid, in such a manner that it shall underlie 
the fluid tested, the plane of contact between the 
two fluids being thus sharply defined. The name 
Horismascope, derived from the Greek, implies that 
the instrument is for the examination of this "boun- 
dary" between two fluids. 

DIRECTIONS FOR USE. 

In testing urine for albumin with nitric acid, 
fill the large tube of the Horismascope two thirds 
full of the urine, which must be made perfectly 
clear and transparent if necessary by filtration. 
Then pour into the funnel tube 25 or 30 minims of 
nitric acid, which will pass down through the capil- 
lary tube and form a layer underlying the urine. 
If albumin is present, a distinct white zone will 
presently appear at the point of contact, sharply de- 
fined against the black background, the amount of 
albumin being indicated by the density of the 
opaque ring. Sometimes air will remain in the 
capillary tube of the instrument preventing the acid 
from running down the tube. It is always best to 
see that the tube is free from air before pouring in 



22 



THE HORISMASCOPE. 



the acid. If air is present it can generally be 
driven out by merely tilting the instrument or it 
may be driven down the tube by placing the thumb 




or middle finger on top of the funnel so as to cover 
it completely and pressing quickly and forcibly so 
as to cause a few bubbles of air to pass through the 
urine. 

L.ofC. 



THE HORISMASCOPE. 23 

In the use of the Horismascope in applying the 
nitric acid test for albumin, the following advan- 
tages are secured. 

1. The acid where it comes in contact with 
the urine is of full strength rendering the test much 
more delicate than as ordinarily applied. 

2. The reaction is not liable to be obscured 
by separation of uric acid or urates, such separa- 
tion not taking place in the Horismascope until 
after a considerable interval. 

3. The black and the white backgrounds of 
the instrument render much more distinct the ef- 
fects produced by the reagent. 

4. No especial skill is required on the part of 
the operator. 

The faintest visible trace of albumin as shown 
by the nitric acid test may be stated to be 1-60 per 
cent. One-fourth of one per cent, is just sufficient 
to make the albumin layer opaque when viewed 
from above. If larger amounts are present the 
percentage may be approximately estimated by 
diluting the urine until the opacity is reduced to 
that corresponding with 0.25 per cent. 

There are many other tests which can be ad- 
vantageously made by introducing the reagent 
from beneath, allowing it thus to form a distinct 
stratum underlying the fluid to be tested. The 
more important of these have been noticed in the 
foregoing pages. 



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